The Chair welcomed all present and requested that any member declarations of interest should be advised in advance of relevant items.

Transcription

1 Minutes of the Scottish Antimicrobial Prescribing Group Meeting Held on Monday 29 th October 2012 Healthcare Improvement Scotland, Delta House, Glasgow Present: Professor Dilip Nathwani (Chairman), NHS Tayside Professor Bob Masterton, Executive Medical Director, NHS Ayrshire & Arran (teleconference) Professor Marion Bennie, Chief Pharmaceutical Advisor, National Medicines Utilisation Unit, Information Services Division Ms Helen Maitland, Programme Director HAI, NHS Education for Scotland Mr William Malcolm, Pharmaceutical Advisor, Health Protection Scotland Dr Stephanie Dundas, Consultant in Infectious Diseases, NHS Lanarkshire Dr Susan Smith, Consultant Microbiologist, NHS Fife Dr Gail Haddock, General Practitioner, NHS Highland (teleconference) Mrs Alison Wilson, Director of Pharmacy, NHS Borders Ms Ysobel Gourlay, Lead Antimicrobial Pharmacist, NHS Greater Glasgow and Clyde Dr AnneMaree Wallace, Director of Public Health, NHS Forth Valley Mr Sam Whiting, Infection Control Manager, NHS Borders Mrs Liz McClurg, Infection Control Manager, NHS Highland (teleconference) Mr Willie McGregor, Senior Charge Nurse, NHS Lothian Professor Ian Gould, Consultant Microbiologist, NHS Grampian and Scottish Microbiology and Virology Network Dr Andrew Seaton, NHS Greater Glasgow and Clyde, Antimicrobial Management Team Mrs Alison Macdonald, Lead Antimicrobial Pharmacist, NHS Highland (teleconference) Dr Nicholas Reid, Lead Antimicrobial Pharmacist, NHS Ayrshire & Arran Professor Kevin Rooney, SPSP Clinical Lead for Sepsis, NHS Greater Glasgow Ms Catriona Innes, Antimicrobial Pharmacist, NHS Orkney Dr Camilla Wiuff, AMR Lead, Health Protection Scotland Dr David Wilks, Consultant Physician, NHS Lothian Ms Julie Wilson, AMR Manager, Health Protection Scotland Susan Roberts, Antimicrobial Pharmacist, NHS Dumfries and Galloway (for Martin Connor) Dr John Porter, UK Medical Team Lead for Specialty Medicines, Pfizer Mr Graeme Bryson, Prescribing Advisor, NHS Ayrshire and Arran In attendance: Dr Jacqueline Sneddon, Project Lead Scottish Antimicrobial Prescribing Group Ms Susan Paton, Project Officer, Scottish Antimicrobial Prescribing Group Ms Andrea Patton, Information Analyst, Scottish Antimicrobial Prescribing Group Mr Andrew Wilkinson, Head of Healthcare Associated Infection and Regulation Team, Scottish Government Apologies: Mrs Anne Lee, Chief Pharmacist, Scottish Medicines Consortium Professor Peter Davey, University of Dundee, International Liaison Dr Emma Watson, Director of Medical Education, NHS Highland Dr Alistair Leanord, Consultant Microbiologist, Health Protection Scotland Dr Lorna Willocks, HAI Senior Medical Advisor, Scottish Government 1

2 Dr Grant Archibald, Director, Emergency Care and Medical Services, NHS Greater Glasgow and Clyde Ms Vicky Elliott, Information Analyst, Information Services Division Mrs Helen Cadden, Public Partner Mrs Arlene Brailey, Assistant Director of Pharmacy, NHS Education for Scotland Dr Alexander Mackenzie, Consultant in Infectious Diseases, NHS Grampian Dr Peter Christie, Consultant in Public Health Medicine, Healthcare Improvement Scotland Dr Alexander Crighton, Consultant in Oral Medicine, NHS Greater Glasgow & Clyde Dr Craig Williams, Infectious Diseases Doctor, NHS Greater Glasgow and Clyde Dr Simon Hurding, Medicines Management Adviser, NHS Lothian Dr Martin Connor, Consultant Microbiologist, NHS Dumfries and Galloway Observers: Ms Shona Cairns, Senior HAI Epidemiologist, HAI and Antimicrobial Prescribing, Prevalence Survey Team Mrs Rebecca Houston, Antimicrobial Pharmacist, Golden Jubilee National Hospital Mrs Yvonne Semple, Lead for the Gentamicin & Vancomycin (GaV) Team, University of Strathclyde Mr Stephen Dewar, Clinical Researcher, GaV Team, University of Strathclyde Dr Alison Thomson, Senior Lecturer, University of Strathclyde Mr David Maxwell, GaV team, University of Strathclyde 1. Welcome and Apologies Action The Chair welcomed all present and requested that any member declarations of interest should be advised in advance of relevant items. The Chair advised of apologies as noted above. The Chair announced the retirement of Professor Bob Masterton. Bob has been a part of SAPG since the inception of the group playing a key part as Vice Chair of SAPG and will be very much missed. The Chair thanked Bob for all his input to SAPG. The Chair announced the resignation of Dr John Porter, ABPI representative and thanked John for his input to SAPG. The Chair welcomed new member Julie Wilson, who has taken over as Antimicrobial Resistance Programme Manager at HPS The Chair advised that two items would be discussed earlier in the agenda: Pre Hospital use of antibiotics by Scottish Ambulance Service. (Paper 5) Update on SPSP Sepsis & VTE collaboration. 2. Minutes of the previous meeting held on 27 th August 2012 The minutes of the meeting held on 27 th August 2012 were agreed. 2

3 3. Matters Arising Publication of revised Scottish Intercollegiate Guideline Network (SIGN) Guideline 88 Bacterial Urinary Tract Infection (UTI) JS updated that the SIGN 88 Bacterial UTI patient version is now available and SIGN 88 will be added to the SIGN App. at the next update. Items for Discussion and Agreement 4. Scottish Patient Safety Programme (SPSP) Sepsis and Venous thromboembolism (VTE) collaboration KR reported that there is strong clinical involvement in the SPSP Sepsis/VTE collaborative and communication with clinicians is taking place via Webex and site visits. Nine boards are reporting data and every board is testing with regards to sepsis although the time constraints with input of data are proving challenging. World Sepsis day on September 13 th was supported by the Cabinet Secretary and a motion was passed in the Scottish Parliament. The next event will be SPSP Learning Session 9 and two of the afternoon breakout sessions will focus on Sepsis and VTE. The next collaborative event is scheduled for 21 st March The tender for evaluation of the Sepsis/VTE collaborative has been awarded to the Sapphire group from the University of Leicester who will provide regular reports on progress. Work on validation of using blood cultures as a proxy measure for sepsis is progressing in Tayside, Glasgow and Ayrshire. 5. Pre-hospital use of antibiotics by Scottish Ambulance Service. (Paper 2) KR presented Paper 2 which was developed in collaboration with the Scottish Ambulance Service (SAS). The paper has been submitted to seek SAPG support for initiation of antibiotic therapy by paramedics in pre-hospital settings where patients with sepsis are likely to have a delay in transfer to hospital due to geographic location. Following extensive discussion SAPG concluded that they have reservations about supporting this development and some additional scoping work was suggested. The Chair advised that following these issues being addressed a revised protocol could be tested in two or three boards. NHS Fife and NHS Highland have already indicated they would be keen to participate in such a project. Antibiotics suggested for pre-hospital use were not discussed by SAPG as it was agreed that details of the intervention required clarification first. KR thanked SAPG members for their input and agreed to take the group s suggestions back to SAS for further discussion. Action: Discuss with SAS and develop a proposal to address the issues raised for presentation at future SAPG meeting KR 3

4 6. Clostridium difficile infection and Mortality Analysis Plan. (Paper 1) AP advised Paper 1 presents a proposal for analysis of intended and unintended consequences of changes to antibiotic policies in all NHS boards in Scotland and details data sources available at national and local level. The Chair highlighted that this is an important piece of work which will inform the proposed infection informatics hub but that timeframes and resource requirements are required. AP advised that discussions are ongoing with Information Services Division (ISD) and Scottish Care Information (SCI) Store which will provide this additional information. Action: The analysis plan was agreed by SAPG and AP will update when appropriate AP 7. Revised Staph. Aureus bacteraemia algorithm. (Papers 3 and 3a) JS advised the SAB algorithm development group had been reconvened and their comments used to update the algorithm. The revised algorithm has been circulated to the Scottish Microbiology and Virology Network (SMVN) for feedback. A few further minor amendments were suggested and accepted. DW highlighted that the vancomycin online calculator issue had not been resolved as the algorithm suggests a trough of 15-20mg/L while the calculator suggests 10-15mg/L. RM advised that he had recently reviewed the evidence for higher levels and they do not appear to produce better clinical outcomes but may increase toxicity. Action: Evidence to be sent to JS to inform final version of algorithm RM Following discussion of the evidence supporting higher levels DN advised that consultation with SMVN to reach a consensus on this issue would be useful. Action: IG to raise at SMVN and advise JS of consensus. IG The revised version will be agreed with SAPG via Action: Final version to be agreed virtually JS 8. Healthcare Associated Infection (HAI) Point Prevalence Survey (PPS) proposed further analysis. (Paper 4) WM advised that prior to identifying priorities for further analysis, feedback on local actions to address the key recommendations would be beneficial. Pre-work in advance of the strategy event in November will be sent to Antimicrobial Management Team (AMT) leads to inform this work. Following the November strategy event areas for further analysis will be discussed and presented in a further paper for agreement at SAPG Actions Paper for December SAPG. WM/JS 4

5 9. HAI Point Prevalence Survey Options Appraisal. (Tabled papers) SC talked to the tabled papers and advised that input is sought from SAPG on future HAI options for discussion by the PPS working group. SAPG and other stakeholders are asked to consider financials, epidemiology and how useful data from the 2011 PPS has been at national and local level to shape future surveys. The Chair highlighted that a huge resource has been Invested in the 2011 PPS and invited discussion on what it has provided to identify priorities for change. It was agreed the data has demonstrated changes in HAI prevalence and antimicrobial prescribing which will inform the HAI task force delivery plan and local areas for quality improvement. It was also agreed that the data is required to inform future strategy and that while annual surveys are not feasible every 3 or 5 years would be acceptable. MB reflected on the manpower requirement for future PPS and suggested that the infection intelligence hub currently being developed will allow routine data to be utilised to inform strategy. The Chair concluded that Option 4b every 5 years appeared the most popular option but that all SAPG members should submit their personal comments for collation as the SAPG response to the consultation. Action: Comments on options appraisal to be sent to SP by 3 rd December 2012 ALL 10. Gentamicin and Vancomycin Quality Improvement Project (GaVQIP) (Papers 5 and 5a) YS advised that the 2 year programme (GaV QIP) has been completed and papers 5 and 5a present the final outputs. For gentamicin all resources have been developed for use with both the Greater Glasgow and Clyde (GGC) dosing regimen and the Hartford dosing regimen. For vancomycin both intermittent and continuous dosing has been included. Guidance YS advised there have been minor changes to the guidance to improve safety and provide additional information for prescribers. The guidance was formally approved by SAPG. Calculators The Hartford online calculator has been validated and both the GGC and Hartford online calculators have been updated to include patient height. It was agreed that the revised GGC calculator should be tested in GGC and Lanarkshire and the Hartford calculator in Grampian for one month prior to being made available to all boards. Subject to successful testing the online calculators were approved for use by SAPG. YS advised that linkage of the calculators with patient data systems will be taken forward as part of the future work on the infection intelligence hub. Documentation YS advised that the GGC prescription and monitoring charts have been fully implemented in GGC and both Ayrshire and Arran and Highland have piloted them with positive feedback. Some minor additions have been suggested to clarify how to manage 5

6 suspected ototoxicity. The GGC charts were approved by SAPG subject to these minor amendments. A similar Hartford chart will be tested in Grampian and Tayside and it was agreed SAPG will await the outcome of this before approval. This work will be coordinated and fed back to SAPG by the Association of Scottish Antimicrobial Pharmacists (ASAP). Action: Update on testing of Hartford gentamicin charts at future SAPG meeting NR YS advised that the charts for vancomycin have not progressed as much as those for gentamicin. There are two proposed templates which reflect differences of approach across boards and the short life working group favours the cardex style chart over the version similar to the gentamicin charts. The Chair suggested the cardex version should be tested first and this was agreed by members. YS advised she will be attending the ASAP meeting on 12 th November to seek volunteers to progress this. It was agreed that ASAP should also feed back to SAPG on the vancomycin charts Action: Update on testing of vancomycin charts at future SAPG meeting NR Education resource YS updated on development of the new learning materials which includes general information on use of gentamicin and vancomycin plus a series of case studies. The content has been agreed and the next stage is working with NES is to develop delivery methods via Learnpro. Working towards completion by the end of March 2013 then user testing will be required. Action: Update at February SAPG meeting YS JS advised that the revised guidance, calculators and documentation will replace the current GaV resources on the SAPG website within a new GaV section to be made available in January Action: New Gentamicin and Vancomycin resources on SAPG website SP/YS The Chair and Vice Chair thanked the GaV team for an excellent piece of work. Items for Update 11. Scottish Intercollegiate Guideline Network (SIGN) 104 Antibiotic Prophylaxis in Surgery JS advised that the evidence review is near completion and the group have been asked to prepare considered judgements which will be taken forward by SIGN. The Chair suggested a paper for SAPG to review the considered judgments would be helpful to ensure consensus. Action: Paper on SIGN 104 for December SAPG. JS 6

7 YG advised that GG&C are currently reviewing antibiotic re-dosing during surgery and questioned whether this issue is part of the current selective SIGN review. JS advised that this was not within the scope of the review so it was agreed that the Association of Scottish Antimicrobial Pharmacists (ASAP) and SAPG should look at this with a view to developing national advice to standardise practice. Action: Paper on re-dosing in surgical prophylaxis at future SAPG JS/NR 12. Business Case and Feasibility Study for Infection Intelligence Hub RM fed back on progress with development of the proposed infection intelligence hub. The linkage of national databases for infection control and antimicrobial stewardship had been agreed as being both feasible and desirable. However careful management will be required and the HAI policy group will require details of the benefits of the investment required and assurance of IT delivery. MB and JR will lead production of a business case and a stakeholder group will inform this process. MB advised an update will be presented at the SAPG event in November and that some early feasibility work is underway utilising national datasets and local datasets within NHS Lanarkshire to replicate the work in Tayside on surgical prophylaxis. 13. UK Antimicrobial Resistance Strategy JS advised that the devolved nations have had input to the new UK Antimicrobial Resistance Strategy 2012 being led by the Department of Health (DoH). The strategy will be published in early 2013 and will inform the update of the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP). 14. European Antibiotic Awareness Day Materials have now been delivered to boards (29 th October) and will support local activities. A template to allow AMTs to feedback has been issued for completion by the end of November and the feedback will inform the UK submission to ECDC. 15. SPSP Sepsis VTE Collaboration Taken at beginning of meeting. 16. Protocol for using Blood culture as Sepsis outcome measure. Taken at beginning of meeting. 17. Undergraduate and postgraduate education on antimicrobial stewardship JS advised that further to work on an MSc module at University of Strathclyde discussions have now taken place with Robert Gordon University Pharmacy Department. They are currently restructuring their undergraduate programme and are keen to have a guest lectures on HAI and stewardship delivered by JS or WM. 7

8 The Chair advised that the work undertaken by Professor Hamish McKenzie on medical undergraduate training required to be followed-up as it is uncertain how different Medical schools teach and train in terms of antimicrobial stewardship. HM advised of the difficulty in influencing undergraduate schools but assured this was being addressed within nursing. GH advised that another approach might be to target individual modules for postgraduate trainees as they have training days where this could be covered. CI advised that as part of the new clinical skills for medical undergraduates includes antibiotic prescribing. HM added that the health foundation HAI and quality improvement sector are also looking at this. Action: Contact Hamish McKenzie to request an update on progress with medical undergraduate curricula SP 18. Primary Care Education Resource Further to the tabled paper on the primary care education project at the last meeting of SAPG, Graeme Bryson has been appointed as Project Manager and will work with NHS Education for Scotland (NES) one day per week to develop the new training programme with timescale of 31 st March 2013 to have working prototype. Action: Paper for April 2013 SAPG meeting GB Items for Information 19. Future Development Day The Chair urged members to register for the event and respond to the pre-work questions which will be circulated in advance of the strategy event on 13 th November as this is a chance to influence future strategy. 20. Publication of Clostridium difficile infection work The Chair advised that the NHS Tayside work on Clostridium difficile infection (CDI) and mortality analysis will be published early next year following some additional data analysis. 21. Federation of Infection Societies (FIS) conference JS advised that the orthopaedic surgical prophylaxis study is being presented at FIS along with 2 posters on the CDI mortality analysis and the urinary tract infection (UTI) decision aid. 8

9 22. National Dental Audit. (Paper 7) JS advised that the paper plus a presentation had been provided by NHS Highland following a session there to inform staff about the forthcoming audit. Jan Clarkson from NES who is leading the project has agreed to attend a future SAPG meeting to provide an update. Data collection and submission is voluntary and will start in January AOCB At the last meeting of SAPG, PD had highlighted submission of UK primary care data by the British Society for Antimicrobial Chemotherapy (BSAC) to the European Centre for Disease Prevention and Control (ECDC). BSAC propose that data will be entered using a web based platform and will allow comparison between the 4 UK nations. This proposal was supported and it was agreed that a link to the data from the SAPG website would be helpful. 23. Date of Next Meeting Monday 17 th December at 12:30pm in Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP. (Buffet lunch from 12:00) Following meeting: Monday 18th February